Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023336534 |
---|---|
Provider Name | Martha Alicia Montelongo |
First Address | Lynwood, CA 90262-4024 |
Second Address | Lynwood, CA 90262-4024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 07/05/2010 |